Provider Demographics
NPI:1003225509
Name:TRUJILLO MEDICAL CORPORATION
Entity Type:Organization
Organization Name:TRUJILLO MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENTE
Authorized Official - Prefix:DR
Authorized Official - First Name:ERNESTO
Authorized Official - Middle Name:
Authorized Official - Last Name:LABOY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-283-2800
Mailing Address - Street 1:PO BOX 683
Mailing Address - Street 2:
Mailing Address - City:TRUJILLO ALTO
Mailing Address - State:PR
Mailing Address - Zip Code:00977-0683
Mailing Address - Country:US
Mailing Address - Phone:787-283-2800
Mailing Address - Fax:
Practice Address - Street 1:181 STREET KM 2.1
Practice Address - Street 2:TRUJILLO MEDICAL BUILDING OFIC 101
Practice Address - City:TRUJILLO ALTO
Practice Address - State:PR
Practice Address - Zip Code:00976
Practice Address - Country:US
Practice Address - Phone:787-283-2800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-08
Last Update Date:2015-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR6936208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty